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Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins

BACKGROUND: Discontinuing medications is a complex decision making process and an important medical practice. It is a tool in reducing polypharmacy, reducing health system expenditure and improving patient quality of life. Few studies have looked at how general practitioners (GPs) discontinue a medi...

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Autores principales: Nixon, Michael, Kousgaard, Marius Brostrøm
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936268/
https://www.ncbi.nlm.nih.gov/pubmed/27388025
http://dx.doi.org/10.1186/s12913-016-1495-2
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author Nixon, Michael
Kousgaard, Marius Brostrøm
author_facet Nixon, Michael
Kousgaard, Marius Brostrøm
author_sort Nixon, Michael
collection PubMed
description BACKGROUND: Discontinuing medications is a complex decision making process and an important medical practice. It is a tool in reducing polypharmacy, reducing health system expenditure and improving patient quality of life. Few studies have looked at how general practitioners (GPs) discontinue a medication, in agreement with the patients, from a professional perspective. Three research questions were examined in this study: when does medication discontinuation occur in general practice, how is discontinuing medication handled in the GP’s practice and how do GPs make decisions about discontinuing medication? METHODS: Twenty four GPs were interviewed using a maximum variation sample strategy. Participant observations were done in three general practices, for one day each, totalling approximately 30 consultations. RESULTS: The results show that different discontinuation cues (related to the type of consultation, medical records and the patient) create situations of dissonance that can lead to the GP considering the option of discontinuation. We also show that there is a lot of ambiguity in situations of discontinuing and that some GPs trialled discontinuing as means of generating more information that could be used to deal with the ambiguity. CONCLUSIONS: We conclude that the practice of discontinuation should be conceptualised as a continually evaluative process and one that requires sustained reflection through a culture of systematically scheduled check-ups, routinely eliciting the patient’s experience of taking drugs and trialling discontinuation. Some policy recommendations are offered including supporting GPs with lists or handbooks that directly address discontinuation and by developing more person centred clinical guidelines that discuss discontinuation more explicitly.
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spelling pubmed-49362682016-07-07 Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins Nixon, Michael Kousgaard, Marius Brostrøm BMC Health Serv Res Research Article BACKGROUND: Discontinuing medications is a complex decision making process and an important medical practice. It is a tool in reducing polypharmacy, reducing health system expenditure and improving patient quality of life. Few studies have looked at how general practitioners (GPs) discontinue a medication, in agreement with the patients, from a professional perspective. Three research questions were examined in this study: when does medication discontinuation occur in general practice, how is discontinuing medication handled in the GP’s practice and how do GPs make decisions about discontinuing medication? METHODS: Twenty four GPs were interviewed using a maximum variation sample strategy. Participant observations were done in three general practices, for one day each, totalling approximately 30 consultations. RESULTS: The results show that different discontinuation cues (related to the type of consultation, medical records and the patient) create situations of dissonance that can lead to the GP considering the option of discontinuation. We also show that there is a lot of ambiguity in situations of discontinuing and that some GPs trialled discontinuing as means of generating more information that could be used to deal with the ambiguity. CONCLUSIONS: We conclude that the practice of discontinuation should be conceptualised as a continually evaluative process and one that requires sustained reflection through a culture of systematically scheduled check-ups, routinely eliciting the patient’s experience of taking drugs and trialling discontinuation. Some policy recommendations are offered including supporting GPs with lists or handbooks that directly address discontinuation and by developing more person centred clinical guidelines that discuss discontinuation more explicitly. BioMed Central 2016-07-07 /pmc/articles/PMC4936268/ /pubmed/27388025 http://dx.doi.org/10.1186/s12913-016-1495-2 Text en © Nixon and Kousgaard. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Nixon, Michael
Kousgaard, Marius Brostrøm
Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins
title Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins
title_full Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins
title_fullStr Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins
title_full_unstemmed Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins
title_short Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins
title_sort organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936268/
https://www.ncbi.nlm.nih.gov/pubmed/27388025
http://dx.doi.org/10.1186/s12913-016-1495-2
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